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Dear Amy: I have been in a difficult marriage and have struggled with health issues and depression. I also have two kids with special needs. Some days it takes all of my energy to cope with everything on my plate.

I have felt very alone as I have struggled to manage these challenges. My mother isn't the kind of mom who offers help or expresses interest in my life. It has been heartbreaking for me.

She has done some kind things, like dropping off goodies for my children. We always thank her in person or call her to thank her, but she expects a written thank-you note for every single gesture.

While I am very appreciative, I often do not have the energy to write and mail a thank-you note after I've already verbally thanked her. My intent isn't to be rude — I'm just overwhelmed.

After she and my father have come for dinner, they each write a thank-you note and mail them to us. It would be so sweet, if not for the pointed nature of the notes, which imply that we are not doing the same.

What should I do?

Amy says: Thank-you notes are meant to express gratitude. They are not meant to be used as a tool for passive-aggressive people to lord their good manners over others.

A verbal thank-you — delivered in-person or via a phone call — should be considered an adequate and proper thank-you, especially when it is expressed to family members whom you see regularly.

It would be nice for you to perhaps prompt the kids to draw/write a message of love for their grandparents, and for you to send them through the mail — for no specific reason.

Nurse makes her sick

Dear Amy: I work closely with a coworker who constantly snorts, coughs, belches and hacks like a cat coughing up a hairball. This goes on all day, every day.

I know she has allergies, as well as asthma. She coughs phlegm into a tissue without washing her hands.

We are nurses, and she does this while treating patients in their rooms. I have told her I could hear her in patient rooms when she was at the nurse's desk or in the hallway, but she just laughs and says, "Sorry."

I have talked with my supervisor, and I know she has discussed it, but it continues. What can I do?

Amy says: You might be annoyed but, speaking as a potential patient, I am horrified.

Yes, the sounds your coworker makes are annoying for you and others. And yet I was trapped by this phrase: "coughs phlegm into a tissue without washing her hands."

Yikes! You are health care workers? Working directly with patients?

Your fellow nurse obviously cannot prevent some of her impulses, due to her health conditions. But this hand-washing issue must be dealt with, and all health- and safety-related protocols strictly observed.

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